Provider Demographics
NPI:1730579384
Name:INCIARTE, JENNIFER (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:INCIARTE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUZANNE
Other - Last Name:BORGERDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 WHITE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-8315
Mailing Address - Country:US
Mailing Address - Phone:580-304-2493
Mailing Address - Fax:
Practice Address - Street 1:200 WHITE EAGLE DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-8315
Practice Address - Country:US
Practice Address - Phone:580-304-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health